Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2010 | Month : April | Volume : 4 | Issue : 2 | Page : 2330 - 2336 Full Version

Diagnostic Applications of Saliva


Published: April 1, 2010 | DOI: https://doi.org/10.7860/JCDR/2010/.675
GHALAUT P* , GHALAUT V** , YADAV S*** , **** LEKHVANI S , YADAV A *****

*Assistant Professor Dental College Rohtak ** Senior Professor and Head Biochemistry *** Demonstrator Biochemistry **** Assistant Professor Biochemistry ***** Assistant Professor Medicine Department Of Dental, Biochemistry and Medicine Post Graduate Institute of Medical Sciences Rohtak

Correspondence Address :
Dr.Surabhi Yadav,Demostrator,House No -1- Couple HostelMedical Enclave,Pgims Rohtak Haryana (India)Pin- 124001,Email - surabhiyadavdr@gmail.com

Abstract

Saliva is an easily accessible fluid that is rich in various proteins and enzymes. In addition to this, many drugs are also secreted in the saliva. It offers several advantages over blood as it is collected non-invasively and with much ease. In this article, the authors review various diagnostic applications of saliva.

Introduction
This review examines the diagnostic applications of saliva for systemic diseases. As a diagnostic fluid, saliva offers distinctive advantages over serum, because it can be collected non-invasively by individuals with modest training and fewer complications occur as compared to those seen during blood collection. Furthermore, saliva may provide a cost-effective approach for the screening of large populations. Whole saliva is most frequently used for the diagnosis of systemic diseases, since it can be readily collected and as it contains the same constituents as that of serum. These constituents are derived from the local vasculature of the salivary glands and also reach the oral cavity via the flow of the gingival fluid (Table/Fig 1).

Saliva has protective properties and contains a variety of antimicrobial constituents and growth factors. In addition, saliva has lubricating functions and aids in the digestion of food. The functions of saliva and the salivary constituents responsible for these functions are summarized in (Table/Fig 2).

Saliva can be collected either by a draining method in which saliva is allowed to drip off the lower lip or by the spitting method in which the subject spits saliva into a test tube (1).

Traditionally, saliva tests were used to detect hepatitis, tuberculosis or strep throat. Today, technology uses highly sensitive methods of detection that have turned saliva into a tool for the diagnosis of many conditions.

Analysis of saliva may be useful for the diagnosis of hereditary disorders, autoimmune diseases, malignant and infectious diseases, endocrine disorders, as well as for the assessment of the therapeutic levels of drugs and for the monitoring of illicit drug use.

Systemic Diseases (Hereditary, Autoimmune, Malignancy)
Hereditary Diseases


Cystic fibrosis (CF) is a genetically transmitted disease of children and young adults, which is considered as a generalized exocrinopathy. Elevated levels of calcium and proteins in submandibular saliva from CF patients were found and resulted in a calcium-protein aggregation which caused turbidity of saliva (2).The submandibular saliva of CF patients was also found to contain more lipid than the saliva of non-affected individuals and the levels of neutral lipids, phospholipids, and glycolipids were elevated (3). Elevations in electrolytes (sodium, chloride, calcium, and phosphorus), urea and uric acid and total protein were observed in the submandibuar saliva of CF patients (4).

21-Hydroxylase deficiency is an inherited disorder of steroidogenesis which leads to congenital adrenal hyperplasia. In non-classic 21-hydroxylase deficiency, a partial deficiency of the enzyme is present. Early morning salivary levels of 17-hydroxyprogesterone (17-OHP) were reported to be an excellent screening test for the diagnosis of non-classic 21-hydroxylase deficiency, since the salivary levels accurately reflected the serum levels of 17-OHP (5).

A saliva-based miniature system can provide a powerful platform for rapid DNA extraction and for the detection of genetic diseases. The mutated alpha-globin gene which is associated with alpha-thalassemia-1 can be detected in saliva by several critical modules, including a genomic DNA (gDNA) extraction module, a polymerase chain reaction (PCR) module and an external optical detection module, all within less than 1 hr (6).

Autoimmune Disease
Sjögren's syndrome (SS) is an autoimmune exocrinopathy of unknown aetiology. SS is characterized by the presence of a lymphocytic infiltrate (predominantly CD4+ T-cells) in the salivary gland parenchyma (7). A low flow rate and an abnormally low stimulated flow rate of whole saliva are also indicators of SS. Autoantibodies, especially of the IgA class, can be synthesized in salivary glands and can be detected in the saliva of SS patients prior to their detection in the serum. In addition to IgA, saliva has also been reported to contain IgG autoantiboiesd (8). SS anti-La antibodies were primarily found in the saliva of patients whose resting and stimulated whole saliva flow rates were abnormally low (9). The expression of human beta-defensins 1 and 2 are decreased in salivary glands which are affected by Sjögren's syndrome in comparison with the human beta-defensin expression patterns in the salivary glands from normal subjects (10).

Caeliac disease (CD) is a lifelong immune-mediated disorder which is caused by the ingestion of wheat gluten in genetically susceptible persons. Gluten stimulates naive lymphocytes directly in the oral cavity, which would have important implications for the understanding, diagnosis, and the management of CD by measuring CD-associated antibodies in saliva as a screening test (11).

Malignancy
A number of recent studies have focused on oncogenic marker detection and its monitoring in saliva. The latest clinical and laboratory findings on diagnostic markers of oropharyngeal carcinoma in oral fluid could be the beginning of their wider use as a diagnostic medium. Oral fluid can also be also used to diagnose other malignancies such as breast cancer, which was one of the first malignant tumours to be detected using genetic protein biomarkers (12).

Patients of head and neck carcinomas show reduced IgA levels in saliva but not in the serum. Causes associated with decreased salivary IgA levels like malnutrition, stress and tobacco could be related to these findings (13).

Salivary analysis may aid in the early detection of certain malignant tumours. P53 is a tumour suppressor protein which is produced in cells; p53 antibodies can also be detected in the saliva of patients who are diagnosed with oral squamous cell carcinoma (SCC) and can thus assist in the early detection of and screening for this tumour (14). Autoantibodies against p53 proteins (p53 abs) can be detected in the serum, ascites, saliva and pleural effusions of various cancer patients (15). Elevated levels of salivary defensin-1 were found to be indicative of the presence of oral SCC (16).

Elevated levels of recognized tumour markers c-erb-2 and cancer antigen 15-3 (CA15-3) were found in the saliva of women who were diagnosed with breast carcinoma, as compared to patients with benign lesions and healthy controls (17).
Elevated salivary levels of CA 125 were detected in patients with epithelial ovarian cancer. A positive correlation was found between salivary and serum levels of CA 125 (18).

A surface immobilized optical protein sensor has been utilized to detect Interleukin-8 (IL-8) protein, an oral cancer marker in saliva (19). Neutrophil levels in saliva may also indicate successful bone marrow transplant in haematological malignancies (20).

Drug Monitoring
As with other body fluids (i.e., serum, urine, and sweat), saliva has been proposed for the monitoring of the systemic levels of drugs (21). The pka of the drug (the ph at which 50% of the drug molecules are ionized) and the ph gradient between plasma and saliva determine the concentration gradient on both sides of the membrane and influence the availability of a drug in saliva (22). A significant correlation exists between salivary and serum lithium levels in patients receiving lithium therapy (23). Saliva is also useful for the monitoring of anti-epileptic drugs like cyclosporine, theophylline, digoxin, Quinine, etc. (24),(25),(26).

Saliva can be an alternative specimen for the therapeutic monitoring of cyclosporine (CsA) in children and patients with difficult venous access. For a highly protein-bound drug such as CsA, saliva may also provide a practical approach for measuring the unbound concentration (27).

The trans-3'-hydroxycotinine(3HC)/cotinine (COT)3HC/COT ratio derived from nicotine which has either been administered as a probe drug or from tobacco use which is measured in either plasma or saliva, is highly correlated with the oral clearance of nicotine. This ratio appears to be a useful noninvasive marker for the rate of nicotine metabolism (which is important in studying nicotine addiction and smoking behaviour), as well as a general marker for measuring CYP2A6 activity (which is important in studying drug and toxin metabolism) (28).

Drug Abuse/Recreational Drugs can also be monitored eg Amphetamines, Ethano (29).

Monitoring of Hormone Levels
Saliva can be analyzed as a part of the evaluation of endocrine function. Salivary cortisol levels were found to be useful in identifying patients with Cushing's syndrome and Addison's disease and also for monitoring the hormone response to physical exercise and the effect of acceleration stress (30). Evidence shows that salivary cortisol in evening samples or in those following dexamethasone suppression provides a reliable and effective screen for Cushing's syndrome (31). Measurement of an elevated late-night salivary cortisol has greater than 90% sensitivity and specificity for the diagnosis of endogenous Cushing’s syndrome. Late-night salivary cortisol measurements are also useful to monitor patients in remission and/or those having recurrence after pituitary surgery for Cushing’s disease. (32).

Salivary aldosterone levels demonstrated a high correlation with serum aldosterone levels (33). Increased aldosterone levels are found in both the serum and the saliva of patients with primary aldosteronism -Conn's syndrome. Measurement of aldosterone in saliva presents a useful and convenient method for application in multi-sampling studies (34).

Testosterone and dehydroepiandrosterone havealso been identified in saliva. Salivary testosterone levels are used for the assessment of testicular function (35). Monitoring salivary testosterone levels may also be useful in behavioural studies of aggression, depression, abuse and violent and antisocial behaviour (36).

It is well known that late-onset hypogonadism in males can cause a variety of symptoms and that the differential diagnosis is relatively difficult, including psychological disorders, stress, and mood disturbances. The levels of serum cortisol can be measured to reflect a patient's level of stress. Simultaneous measurement of testosterone and cortisol levels in saliva is done by liquid chromatography-tandem mass spectrometry (LC-MS/MS) (37).
Salivary estriol levels are used as a means for the assessment of foeto-placental function (38). Decreased salivary estriol was suggested as a marker for foetal growth retardation (39).

Salivary progesterone levels can be useful for the prediction of ovulation, demonstrating a correlation of 0.75 with serum progesterone levels and salivary oestradiol and progesterone levels can be used for the evaluation of ovarian function. An increased salivary estriol-to-progesterone ratio may be a predictor of pre-term delivery (40).

To study pineal function in newborn infants, saliva collection using cotton buds and the measurement of melatonin in saliva offers a valid, non-invasive, pain-free and practical alternative to blood sampling and for the determination of serum melatonin (41).

Diagnosis of Oral Disease with Relevance for Systemic Diseases
Saliva can be used for the detection of oral candidiasis and salivary fungal counts may reflect mucosal colonization. Saliva may also be used for the monitoring of oral bacteria (42). Bacteria (including anaerobic species) can survive in saliva and can utilize salivary constituents as growth media). Furthermore, increased numbers of Streptococcus mutans and Lactobacilli in saliva were associated with the prevalence and the presence of increased root caries (43). Saliva can serve as a vector for bacterial transmission and also as a reservoir for bacterial colonization. Detection of certain bacterial species in saliva can reflect their presence in dental plaque and in periodontal pockets (44).

The collection and analysis of Gingivalcrevicular fluid (GCF) are noninvasive methods which are used for the evaluation of host response in periodontal disease. These analyses mainly focus on inflammatory markers such as prostaglandin E2, neutrophil elastase and beta-glucuronidase and on the marker of cellular necrosis-aspartat aminotransferase. Further, the analysis of inflammatory markers in GCF may assist in defining how certain systemic diseases (e.g., diabetes mellitus) can modify periodontal disease and how peridontal disease can influence certain systemic disorders (atherosclerosis, preterm delivery, diabetes mellitus and some chronic respiratory diseases) (45).

Viral Diseases
Saliva was found to be a useful alternative to serum for the diagnosis of viral hepatitis. Acute hepatitis A (HAV) and hepatitis B (HBV) were diagnosed, based on the presence of IgM antibodies in saliva. Similarly, the analysis of saliva proved to be a highly sensitive and specific method for the diagnosis of viral hepatitis B and C. Saliva may also be used for determining immunization and also for detecting infections such as measles, mumps and rubella (46).

Antibody to HIV in whole saliva of infected individuals, which was detected by ELISA and Western blot assay, correlated with serum antibody levels (47).

Others
Rapid detection of Plasmodium falciparum histidine-rich protein II (PfHRP II ) antigen in saliva may be a useful non-invasive and cost-effective diagnostic technique for malaria (48).

Persons with periodontitis and type 2 diabetes have raised salivary Pro-calcitonin levels that reflect their degree of periodontitis activity and hyperglycaemia (49) . Salivary adiponectin may be used as a marker for the increased risk of non-insulin-dependent diabetes mellitus or for cardiovascular disease (50).

Conclusion

Saliva can be used as an alternative to serum as a biological fluid that can be analyzed for diagnostic purposes. Whole saliva contains locally produced as well as serum-derived markers that have been found to be useful in the diagnosis of a variety of systemic disorders. Whole saliva can be collected in a non-invasive manner by individuals with modest training, including patients. This facilitates the development and introduction of screening tests that can be performed by patients at home.

References

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Navazesh M (1993). Methods for collecting saliva. Ann NY Acad Sci 20:72–77.
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Boat TF, Weisman UN, Pallavicini JC (1974). Purification and properties of the calcium precipitable protein in submaxillary saliva of normal and cystic fibrosis subjects. Pediatr Res 8:531–534.
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